Offices and Clinics of Dentists

SIC 8021

Companies in this industry

Industry report:

This industry consists of offices and clinics of licensed practitioners of dentistry with the degree of D.M.D., D.D.S., or D.D.Sc. Included in this industry are the offices of dentists, dental surgeons, pediatric dentists, endodontists (root canal specialists), oral pathologists (specialists in mouth diseases), orthodontists (specialists in straightening the teeth), periodontists (gum specialists), and prosthodontists (artificial teeth and denture specialists).

Industry Snapshot

According to the U.S. Bureau of Labor Statistics, there were 155,700 dentists in the United States in 2010. Many patients used dental insurance to cover their dental care. In the 1970s, only a small percentage of Americans had dental insurance, but by the 2000s, as dental costs continued to rise, dental insurance became much more common. According to a study conducted by the National Association of Dental Plans, 62 percent of American workers rated dental coverage as an "essential benefit," in 2010, up from 53 percent in 2005.

Employer funding of dental benefits is an area that is expected to continue to experience major changes in the coming years. Medical costs will continue to rise, and health benefits will continue to compete with dental benefits for employer dollars. More employers will be expected to play a bigger role in cost sharing, and contribution programs will become more defined. These factors will affect dental services and the types of services provided. A growing number of patients are frustrated with increasing restrictions from their insurance companies, service limitations, larger co-payments, and annual caps on benefits.

Organization and Structure

The dental profession is divided into eight types of practices carried out at dental offices and clinics: general dentistry, oral and maxillofacial surgery, endodontics, orthodontics, pediatric dentistry, periodontics, oral pathology, and dental public health.

According to the American Dental Association (ADA), at the end of the first decade of the 2000s, approximately 92 percent of active dentists were private practitioners, and the remaining 8 percent were teachers in dental schools, researchers, consultants, and so on. Of those in private practice, about 65 percent worked in a solo private practice, about 21 percent worked with one other dentist, and 14 percent worked in a dental practice with two or more other dentists. About 20 percent were women, and about 20 percent were specialists.

Background and Development

Modern dentistry began in the sixteenth century with the European revival of arts and sciences. According to dental historians, dentistry was being practiced independently from general medicine and surgery as early as 1544. Dentistry and medicine had been united for centuries because both sciences were practiced by barbers. During the sixteenth century important developments of dental instruments designed for cleaning and filling teeth occurred.

In the seventeenth century, dentistry developed into an area of scientific inquiry in the way medicine had for many centuries. In Europe and North America, academic and scientific articles began to appear on dentistry topics. During this time, the occupation of the barber-dentist evolved into that of tooth puller, while a separate practice of dental surgeons began to develop. The practices of periodontics and dental pathology began to develop during the eighteenth century.

Dentistry grew tremendously in the twentieth century. Preventive dentistry and public education on the importance of dental health and hygiene paid off for the industry. The number of patient visits rose significantly, especially for preventive measures. Moreover, elderly patients, unlike previous generations, did not lose their teeth and therefore went to dentists regularly.

Advances in fluoride treatments and dental technology have decreased the number of cavities Americans have. In 1990 Americans had 151 million fillings, half the number of fillings in 1959, even though the population had doubled during that time. The number of root canals, however, tripled.

Income levels play a significant role in the number of times a person visits the dentist. In 1997 approximately 59 percent of people with household incomes between $10,000 and $19,999 indicated they had visited a dentist within the past 12 months, whereas 84.9 percent of people with annual household incomes of $55,000 or more said they had been to a dentist. According to the ADA, in 2007, 67.6 percent of Americans had been to the dentist within the past 12 months. Most middle and upper income households obtain regular dental care, but 100 million Americans--mostly from lower income families--were without dental insurance and often go without regular dental care. With dental care costs rising, that means that the number of untreated cavities actually rose during the first decade of the 2000s, compared to the 1980s. According to a study conducted by the Centers for Disease Control, in the most recent data available, in 2003 and 2004, 27 percent of children and 29 percent of adults had untreated cavities

Technological Advances.
The expansion of this industry during the twentieth century was also due to numerous technological advances. During the 1940s and 1950s, new methods of anesthetics greatly reduced pain during clinical procedures. During the 1960s bonding, where a liquid resin is applied to a tooth, then shaped as it hardens, providing a better fitting and more attractive cap or crown, was developed.

In the late 1980s, orthodontists' offices increased as new types of braces and appliances were developed that were suitable for adults. Clear plastic braces and more cosmetically appealing appliances that fit inside the mouth were marketed for adults undergoing orthodontic treatment. Similarly, dental surgeons provided services for an increasing number of adults wanting to have their jaws realigned for both medical and cosmetic reasons.

Perhaps the most significant technological development for modern dentistry has been the surgical laser, which came into common use at the end of the 1980s. According to a study conducted by Louisiana State University scientists in 2008, a laser-assisted technology called LANAP helped people with periodontitis grow 75 percent more new tissue growth than patients who were treated with traditional dental tools. The bacteria are killed by the laser and the gums heal more quickly and with less irritation.

The Nd:YAG laser was one of the most commonly used lasers by dentists. This laser is used for soft-tissue procedures to heal inflammation and reduce bleeding. Since 1987 Nd:YAG has been studied for its use in hard-tissue cutting procedures, such as working with enamel and metal for orthodontic dentistry. The CO2 laser was the first to be approved by the Food and Drug Administration (FDA) and was another widely used laser in dentistry. It is employed for soft-tissue surgery, such as removing lesions and, like Nd:YAG, has been used experimentally for hard-tissue applications. The third major type of laser is the argon laser, which has been used for soft-tissue procedures, such as curing tissue. All three lasers also have uses for sterilizing dental instruments and are continuously undergoing further developments.

Other significant technological innovations for this industry have been in intra-oral television and T-Scan devices. Both have been utilized to educate patients about the condition of their teeth and the work involved in various procedures. Intra-oral television shows patients an enlarged view of their teeth and gums on a television screen. T-Scan uses a computer screen to show patients the static and dynamic contacts on their teeth. Both of these types of visual aids have helped dentists explain procedures to their patients and make them feel more comfortable.

Dental Office Hazards.
Working with nitrous oxide (commonly known as "laughing gas") has long been a concern of dental office workers. In 1993 this gas was used by nearly 50 percent of all dentists in the United States, primarily by general dentists. Although the government recommends that dentists take in under 25 parts per million of this gas, most dentists get 250 times this amount. Realizing possible health hazards, this industry has tried to lower the amounts that escape by using special types of masks, known as "scavenging systems," that are worn by the patient.

Although the risks of nitrous-oxide exposure are not fully known, the increase in the number of female dentists, dental assistants, and hygienists has drawn attention to reduced fertility among women working in dentists' offices and clinics. The Dental Assistants Association suggested that nitrous oxide exposure could be linked to miscarriages, liver disease, and neurological problems. At the end of the twentieth century, the topic was still hotly debated.

Another cause of concern in dental offices arose with the frequent use of lasers. Lasers can be harmful to both patient and staff if misdirected to the wrong tissue, especially toward the eyes. Given the risks, dentists have taken precautions, such as the use of eye protection and surgical masks specially developed for laser surgery.

Costs of Infection Control.
In 1990 a Florida dentist with AIDS allegedly transmitted the HIV virus, which causes AIDS, to at least three of his patients. Although it is not certain that the patients contracted the virus from their dentist, these cases received much public attention and national publicity. As a result, dentists' offices and associations received thousands of inquiries from concerned patients. Dentists responded to these concerns by investing in more infection-control measures. Moreover, the Occupational Safety and Health Administration enforced additional regulations for the safety of dental office workers, who are believed to be at greater risk of getting AIDS from their patients than vice versa.

Infection control includes the use of disposable items, disinfectants, sterilizers, and ultrasonic cleaners. According to a 1993 study by Clinical Research Associates, infection control cost an average of $9 per patient visit, adding more than $30,000 annually to a dentist's overhead costs, according to Gordon J. and Rella P. Christensen in the Journal of the American Dental Association. These costs have been passed on to patients, with some dentists adding an extra fee labeled "infection control"to their bills/

Traditionally, dentists and dental assistants worked on patients after thoroughly cleaning their hands, but beginning in the early 1990s, dentists and their assistants began donning latex gloves to avoid the spread of germs and disease. By the end of the first decade of the 2000s, gloves and surgical masks were commonly used for almost all dental procedures.

Dental Fraud.
With an overall increase in dental benefits insurance plans starting in the 1980s, the industry was noted for significant amounts of billing fraud. There are basically three types of dental fraud: double-billing, where dentists charge both a patient's insurer and the insurer of the patient's spouse for the same procedure; billing for services not rendered; and manipulating billing codes by "unbundling" a procedure and billing it under several codes. Partially in response to the growing amount of billing fraud in the health care field in general, the Department of Health and Human Services enacted the Health Insurance Portability and Accountability Act of 1996. The act established a national bank to take reports of fraud and abuse and issue regular reports on the issue.

A related problem has been the concern that insurance companies have been "downcoding" dentists' bills. In downcoding, insurance companies price a procedure based on less complex and lower-cost procedures than that reported by the dentist. This is part of a larger problem facing dentists' offices and clinics, with insurance companies playing an important role.

In 2003 the ADA and two member dentists filed a class-action suit against some of the largest insurance companies in the United States. The ADA claimed those insurers, which included CIGNA Corp.; CIGNA Dental Health Inc.; MetLife, Inc.; Mutual of Omaha Insurance Co.; Metropolitan Life Insurance Co.; and Connecticut General Life Insurance Co., violated the federal Racketeer Influenced and Corrupt Organization Act (RICO) and supported state law for insurance abuses against dentists contracted under the insurers' managed-care plans. Included were charges that the insurers illegally paid their in-network dental providers less than their charges for provided dental services and with late payments in states with prompt-pay status; downcoding, or changing the procedure code to a less expensive code; and bundling, or combining codes of two or more performed procedures into one billed procedure.

Marketing.
According to the ADA, less than 1 percent of income from dentists' offices and clinics was spent on advertising in 1993. Traditionally, the industry has taken a nonaggressive approach to advertising because most patients go to a dentist who has been referred to them by other patients or to the dentist their parents sent them to as children. The industry has benefited, however, from indirect advertising. The ADA recognizes that public health programs, as well as toothpaste and mouthwash advertisements, promote preventive dentistry and indirectly advertise for dentists' offices and clinics.

In 1997 Americans spent almost $51 billion on dental services from the nation's 150,090 professionally active dentists, more than 138,000 of whom worked in private practice in an independent office or through a group practice or clinic. Nearly 20 percent of all active dentists in the United States were specialists, with the two largest groups comprising orthodontists and oral surgeons. The total number of board-certified dentists in 1997 exceeded 150,090, but many of those not actively practicing were involved in dental education or research projects.

According to the 1997 Survey of Consumer Attitudes and Behaviors Regarding Dental Issues, conducted by the American Dental Association (ADA), most American adults reported that they had visited a dentist within the prior year. Nearly 60 percent of adult Americans reported that they had visited a dentist in the previous six months, while another 16 percent said they had seen a dentist between 6 and 11 months ago. For most Americans, the factor most influential in making a decision to visit a dentist was the elimination of pain, according to the ADA survey.

The industry has expanded to meet the needs of two growing sectors of the population: the aged and babies. Pediatric dentistry is one of the fastest-growing sectors of the industry. Additional growth has occurred as an increasing number of Americans have acquired dental insurance.

During the 1990s, dental offices and clinics were faced with new challenges related to industry reforms and the rise of managed care. Dentists sought changes in managerial practices and human resources to bring down high overhead costs. With inflation rates for dental care exceeding those for medical care, DMOs were becoming more popular. Growth in DMOs, however, has been slow, with only about 25 percent of people enrolled in one by the end of the 1990s.

Health in the United States is continually improving, with more people aware of the positive effects of hygiene, exercise, and a generally healthy lifestyle. Oral health has also been on the rise, with an increasing number of children and adolescents from 5 to 17 who have never had cavities in their permanent teeth. Adults from 18 to 34 years also have fewer fillings and less decay than ever before. There has been a dramatic decline in people who lose all their teeth. Oral cancer rates are also down.

As a result, dental services continued to shift based on demand for services. Basic services, such as fillings, slowed, and cosmetic dentistry became an increasingly important trend, albeit one that is not covered by insurance companies. Americans spent about $1.3 billion in 2000 on professional teeth-whitening procedures, with analysts predicting a 24 percent growth annually. Cosmetic procedures more than tripled between 1996 and 2000. This gave rise to BriteSmile Professional Teeth Whitening Centers in the early years of the first decade of the 2000s, a Walnut Creek, California-based company that offered one-hour professional laser tooth whitening. The "dental spa" appeared in the early years of the first decade of the 2000s, offering clients a retreat with traditional spa services, including facials, foot massage, and limo service, along with dental treatments. Traditional dentists n began to add spa treatments to their services to attract clients.

Another trend was the significant rise in dental visits by uninsured people, although it was still far less than the percentage of people with private insurance seeing a dentist, according to the ADA. The percentage of people with private dental insurance who visited a dentist in 1999 was 75.2 percent, up from 71.4 percent in 1989. Among those without dental insurance, the percentage rose to 58.1 percent in 1999, up from 47.6 percent in 1987. The total percentage of Americans who reported a dental visit jumped to 64.1 percent in 1999 from 57.2 percent in 1989. However, the percentage of people with private dental insurance dropped to 35.2 percent in 1999, down from 40.5 percent in 1989.

According to the National Health Survey, the U.S. Department of Health and Human Services found that more than two-thirds of the overall population visited a dentist annually, of which 58 percent were 64 or older in the middle of the first decade of the 2000s. Therefore, more than three-fourths of the overall population, as well as two-thirds of individuals 64 and up, will visit a dentist annually by 2020. This represents an estimated 224 million people, of which 55 million will be 64 or older.

Although not new in the international dental community, low cost dental visits combined with vacationing were beginning to emerge in the United States. Skyrocketing medical costs and a reduction in health benefits have prompted a small number of Americans to engage in so-called "tooth tourism," in which travelers, who are often citizens of prosperous countries, travel to less-developed countries for low-cost medical care and a vacation. Web sites, such as toothtourism.com, were one of many offering discounted dental work, while others were offering complete tour packages.

At the end of the first decade of the 2000s, the global economic recession, which was the worst since the Great Depression, was affecting the dental industry. Although those with insurance continued to schedule their regular checkup and routine exams, most of which are covered up to 100 percent by their insurance plans, they were postponing other, more expensive procedures and elective treatments. In addition, the number of uninsured seeking dental treatment and exams also dropped as consumers sought ways to cut back on expenses. California, for example, found itself in a budget crisis in 2009. In response, the state slashed funding in numerous government programs, including Denti-Cal, the dental care program attached to the state's Medi-Cal program. As a result, thousands of lower income residents lost dental benefits, although children retained their coverage. To ease the impact on California's poorest, Western Dental, one of the country's largest dental health maintenance organizations, announced in September 2009 that it would offer reduced rates to low-income and elderly patients.

In May 2009, Minnesota became the first state to sign into law a statute that created mid-level dental providers: dental therapists. Alaska also adopted the concept. Like other states, Minnesota is plagued by the problems of those underserved by the dental industry, comprising primarily low-income, elderly, disabled, and rural households. Individuals who obtain no dental care commonly end up at emergency rooms with much more complicated dental issues. Dental therapists work under the collaborative authority of a dentist to provide preventive services, some restorative services, and extractions of primary teeth. They also have limited authority to prescribe medications. Dental therapists must hold a bachelor's degree from a dental institution. Those with a master's degree may qualify as an advanced dental therapist, who is given additional patient responsibilities without the presence of a dentist.

Current Conditions

According to IBISWorld, dental offices constituted a $110 billion industry in 2011. The value that the industry added to the overall economy was expected to increase almost 3 percent annually through 2017. The IBISWorld report indicated that the industry was resilient during the economic recession at the end of the first decade of the 2000s and "is expected to continue benefiting from favorable demographic trends, improvements in technology, and mounting awareness of the importance of oral hygiene." Challenges included the increasing costs for the education necessary to become a dentist and the high costs of equipping a dental office with the newest technology.

Industry Leaders

CIGNA's national PPO network of dentists has more than 60,000 unique dentists serving patients in more than 130,000 office locations. CIGNA also had one of the largest dental HMO networks in the country, with 13,700 unique dentists in 43,500 office locations.

Workforce

In 2010 there were approximately 155,700 professionally active dentists earning an average annual salary of $146,920. The Bureau of Labor Statistics expected employment in the industry to increase 21 percent between 2010 and 2020.

Although dental assistants may begin their career without a college degree, dentists increasingly are looking for assistants with at least some college education. Most dental assistants are employed by dentists in general practice, although dental specialists, including endodontists and periodontists, employ assistants as well. The average annual wage for dental assistants was $34,710 in 2010. The employment outlook for dental assistants was positive in the 2010s and was expected to grow significantly faster than average for all occupations.

According to the Bureau of Labor Statistics, dental school graduates were expected to keep pace with the large number of dentists of the baby boom generation reached retirement age. Because a majority of dental bills are paid for by individuals after copayments and deductibles or by uninsured individuals who decrease visits to the dentist when the economy is poor, dentistry tends to be cyclical. Dentists tend to prosper when the economy is running smoothly, and their business tends to decrease when the economy stagnates.

© COPYRIGHT 2018 The Gale Group, Inc. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. For permission to reuse this article, contact the Copyright Clearance Center.

News and information about Offices and Clinics of Dentists

Hospital, Employment, and Price Indicators for the Health Care Industry: Third Quarter 1999
Health Care Financing Review; March 22, 2000; 700+ words
...9 2.8 Health Services 2.7 2.7 2.4 1.5 Offices and Clinics of Physicians 4.1 4.3 3.6 3.7 Offices and Clinics of Dentists 3.3 3.1 3.0 2.7 Nursing Homes 2.6 2.3 1.
Beyond the health services industry: other industries that employ health workers.
Occupational Outlook Quarterly; December 22, 1993; 700+ words
...Industries That Employ Health Workers Health services industries(1) Offices of physicians including osteopaths Offices and clinics of dentists Offices of other health practitioners Nursing and personal care facilities Hospitals, public and private...
Few OSHA checks on doctor offices. (Occupational Safety and Health Administration)
American Medical News; December 6, 1993; 700+ words
...indicates those offices have not been singled out for inspections." "Eighty percent of the inspections in the offices and clinics of dentists and physicians have been the result of employee complaints," he says. "And OSHA has responded to them...
Local clinic, dentists try to ease area's pain; Vouchers to provide low-cost dental treatment
The Spokesman-Review (Spokane, WA); March 14, 2005; 700+ words
...Dirne Community Health Clinic moaning and clutching...a Coeur d'Alene dentist, has found a dozen or more dentists willing to accept patients...pay $25 to visit a dentist in the program. The...patient to help cover dentists' costs for supplies...according to the state's Office of ...
Local clinic, dentists try to ease area's pain.
The Spokesman-Review (Spokane, WA); March 14, 2005; 700+ words
...Dirne Community Health Clinic moaning and clutching...a Coeur d'Alene dentist, has found a dozen or more dentists willing to accept patients...pay $25 to visit a dentist in the program. The...patient to help cover dentists' costs for supplies...according to the state's Office of ...
Smiles abound at free dental clinic ; 3 dentists provide no-cost services to the uninsured
The Buffalo News (Buffalo, NY); August 8, 2011; 689 words
A team of dedicated dentists volunteered their time...patients at Lesinski's office on Sweet Home Road in...Lesinski during his office hours now rather than traveling to her regular dentist in Cheektowaga. "With...had began setup at the office at 5:50 a.m. Sunday...this was the first free ...
Mobile Clinics Bring Dentists to the Needy; Appalachian Residents at Special Risk
The Washington Post; July 24, 2005; 700+ words
...trailer as a dental office and a picnic shelter...of the mobile dental offices that travel the hills...group of volunteer dentists working with area Southern...tremendous need, and clinics on wheels can be a...staffed by volunteer dentists who come to the region...off her visit to the ...
Dentist suspended for unsanitary clinic; A dentist was suspended after an inspection found 17 violations of sanitation and proper behavior.(NEWS)
Star Tribune (Minneapolis, MN); March 3, 2012; 428 words
...FRIEDMANN; STAFF WRITER A Minneapolis dentist with a history of disciplinary actions...suspended this week after an inspection of his office in December found an unsanitary environment...Mattingly, who was reached by phone at his office on Friday, declined to comment. He was...

Search all articles about Offices and Clinics of Dentists